How will the CHHiP trial affect the future of prostate radiotherapy?

Abstract

New treatment guidelines are being developed drawing on the results of these RCTs. Based on abstract presentations of the CHHiP Trial data the UK Royal College of Radiologists [13] recommended in December 2016 that acceptable regimens include CONTACT David Dearnaley

Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand

“… 18 , 19 The proportion of men reporting moderate or big urinary or bowel bother was less than 10% and was consistent with the CHHip study. 20 A national cohort study from England 18 also reported no differences in EPIC-26 urinary and bowel function between men receiving HRT or CRT, with mean scores in the order of 86 across the domains and consistent with the findings in this cohort study.…”

“…Variable patterns of uptake have been reported in different health care settings. 5,20,21 PCOR-ANZ is a binational collaboration between Australia and New Zealand. While each country's health care system shares similarities (access to universal health care being key), funding models and the proportion of RT delivered by the private sector differ (36% in Australia vs 10% in New In the US, analyses of the National Cancer Database have reported significant increases in the use of SBRT from less than 1% in 2004 to 7% to 10% by 2015, while use of HRT remained relatively unchanged at 6%.…”

“…EPIC-26 Domain Scores aZealand).22 Funding in Australia for both private and public sectors retains a component of activitybased and fee-for-service models proportionate to the number of fractions delivered, whereas public funding in New Zealand provides a global budget for all services by each facility. By the second half of 2019, the proportion of men receiving HRT in New Zealand was 73% compared with 35% to 58% among Australian jurisdictions.In the UK, where a universal health care model is delivered by the National Health Service (NHS), the use of HRT increased from 8% in 2012-2013 to 49% in 2016-2017 following a conference report of initial results of the CHHiP trial later published 20. In 2017, NHS England undertook to audit RT practice against a benchmark usage rate of 70% for HRT.…”

Seven or less Fractions is Not the Standard of Care for Intermediate-Risk Prostate Cancer

“…Modest hypofractionation for prostate cancer has been estimated to save the National Health Service £28milion per year compared with the previous standard 2 Gy/fraction schedules [44]. Nevertheless, daily treatment for 4 weeks remains a significant burden to healthcare providers, with key costs of longer fractionation including machine and radiographer time.…”

Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives

“…The rationale behind using higher doses in fewer fractions comes from data describing a lower α/β-ratio of prostate cancer than previously thought. Despite ambiguous recommendations from different large trials, hypofractionated radiotherapy is increasingly adopted in guidelines worldwide [10].…”